Future strategies for the treatment of cryptococcal meningoencephalitis in pediatric patients

Abstract

Introduction: Cryptococcal meningoencephalitis (CM) is a rare infection in pediatric patients, which is associated with substantial morbidity and mortality. Since symptoms of this infection are nonspecific, the diagnosis relies on risk assessment and laboratory-confirmed clinical findings. Initial management commonly utilizes amphotericin B and flucytosine, followed by prolonged fluconazole to clear the yeast and prevent relapse. Since no prospective clinical trials have been performed in pediatric patients, much of the data are extrapolated from adult studies and pediatric pharmacokinetic data. This highlights the need for this review and additional studies.

Areas covered: Here, the pathophysiology, epidemiology, presentation and treatment of CM in pediatric patients are described. Additionally, the relative safety and pharmacokinetic differences in pharmacologic treatment between pediatric and adult patients are highlighted.

Expert opinion: Guidelines for the management of pediatric patients with CM are extrapolated from those for adults with HIV. Therefore, pharmacokinetic differences should be considered. Pediatric CM is a treatable disease with many children infected but rarely manifesting disease. Additionally, new advances promise to make an impact on the management and outcome of CM. New antifungal drugs are not likely to be available in the near future for CM treatment.

Keywords::

• amphotericin B
• cryptococcal meningoencephalitis
• fluconazole
• immune reconstitution inflammatory syndrome
• pediatrics

Declaration of interest

J Spivey and R Drew have no disclosures/conflict relative to the topic. J Perfect: research grants, advisory committee participation and consulting fees for Astellas, Pfizer, Merk, F2G, Viamet and Scynexis. The authors have received no payment in preparation of this manuscript.

Notes

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